Gurpal

April 2016 - MRCPsych Paper B - Feedback

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This topic is for everyone who has taken the MRCPsych Paper B exam. Please give your feedback! If you remember any questions from the Paper B exam, please post them!

To discuss the answers to questions, please start a new seperate thread for each question with a clear title. This makes it easier to find relevant discussions.

Good luck on results day!

:)

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Mci to AD less then 10 or 10 to 20

temporal dementia neeuroimging

Ect study questions 

preganacy and breastfeeding antidepressant 

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I thought it was very straightforward which is nervewracking as I feel certain I passed... wondering what others thought

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There was the CEAC curve from last time. EMI, think the questions were"

1. What is the best recommendation for a poor country?

2. at 50000 GBP, what is the probability of remission?

3. something about 3000 GBP, when Lofepramine was the most cost-efective

Other questions that I can remember

The Warwick Edinburgh Mental Well-being thing which was in the April 15 paper that someone had helpfully uploaded. Really can't remember the questiokns.

The first one was a two-group prospective study on Donepezil vs placebo for agitation in AD. I read through the stem again and again, but couldn't find any information on randomization. they asked what type of study it was, and the options were (a) naturalistic outcome (b) cohort (c) crossover (d) double-blind RCT and one more. there was nothing to suggest it was an RCT. But it wasn't any of the others either. the other questions were data based (NNT etc)


There was a set of MCQs using data on regular bedtime at 3,5,7 years and behavioral problems. Think the outcome was categorical, the regression coefficients were presented as sets of three along with significance. they asked what kind of analysis was appropriate. And then a set of data-based questions from there.

About the ones above:
 
the MCQ on MCI conversion rates were for a memory clinic.

the Fronto-temporal dementia one was an EMI:

they wanted two imaging findings for FTD, two for Vascular Dementia: there were functional/structural imaging options. the ones I can remember are: (1) frontal atrophy on MRI (b) microhaemorrhage (c) infarcts in the basal ganglia (c) orbitofrontal/caudate dysfunction (c) reduced dopamine intake in the striatum on SPECT....

the pregnancy one wanted two antidepressants for breast-feeding: options included imipramine and sertraline. the other question was on a woman with severe depression in the third trimester, i picked sertraline again.

Never realised time would be such an issue. 

 

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there was an interesting one on treatment of pathological gambling for a patient with chronic pain on co-codamol (which i assume is a a codeine compound?). options were naltrexone, buspirone, carbamazepine and a couple of others

there was an EMI on a woman with hemiparesis, dystonia and sexual disinhibition

there was one on mutism post-epilepsy

there was one on epilepsy in autism

there was something about antisocial behaviour and gender differences - equal violence in intimate relationships between men and women/ 

there was a ver irritating one which i think is a repeat--the same EMI with naltrexone. the options were alcohol/amphetamines/cocaine/heroin/methadone and cannabis

The questiosn were: naltrexone use in two (alcohol and heroin)

Substituttion treatment: ???? is the answer heroin (the substance treated) or methadone (the substance used to treat)??

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The first one was a two-group prospective study on Donepezil vs placebo for agitation in AD. I read through the stem again and again, but couldn't find any information on randomization. they asked what type of study it was, and the options were (a) naturalistic outcome (b) cohort (c) crossover (d) double-blind RCT and one more. there was nothing to suggest it was an RCT. But it wasn't any of the others either. the other questions were data based (NNT etc)

 

I think I picked an option that had RCT followed by open label extension, or something

Edited by Mmooney
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Mostly new questions very limited repetition 

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I am really pissed off, i think mrcpsych realized lots of ppl passed before bcz of spmm so they decided to completely change the questions! The first 40 questions were sooooo difficult, i think ill fail. This is my first try and i think it will be the last

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Best antidepressant to use with lithium 

Antidepressant with least sexual side effects 

Dysthymia percent 

Percent of psychosis in prison 

Antipsychotic not to use with family history of breast cancer

 

LD and schizophrenia 
Step wise memory loss and autonomic instability 

EMI- infectious diseases 

EMI- descriptions of statistics 

Autism 


Fragile X, rett, hyperactive ? 

Gender ratio the same in... 

Signs of late onset schizophrenia-?more negative signs, more common in men

Most likely reason for poor response to antidepressant ?old ? Psychosis 

Pathological lying 

Most common side effect of donepazil

Most worrying risk in anorexia- BMi<0.5% percentile, k of 3.2, weight <45

Mum having intrusive thoughts 4 months after giving birth causing anxiety and tearfulness. ?OCD or ?schizophrenia
Recurrence of bipolar post natal percent

Which is example of primary prevention 

Suicide in prison. - first time prisoners higher rate? Or younger have lower rates the old? 


Prevention-EMI eg donepazil for 
Dementia EMI- drug to use if cholesterare not useful
Drug to avoid in Lewy body dementia

EMI- tics and ADHD 
Tics only and cholepraxia - two

Defences EMI 
Substance misuse- naltrexone use and substitute medication. 

Different tests-EMI 


Conduct disorder and school interventions 

 


Antidepressant graph 
Ect graph 
First episode psychosis and canabis use- odds ration test 

 

Memory loss with ECT

Idiopathic rem sleep disorder increases risk of? 

 


Frontotemporal and vascular dementia findings

 

cant think of any more!!  

 

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Here are some that I could recall 

There was a question on advance lithium toxicity .....nystagmus and some other options 

A child newly diagnosed with autism. His mother complains of tantrum that she can't explain the cause. options - behaviour analysis, initiate risperidone, initiate melatonin etc

important in Anorexia  - bmi of 0.4th centile, Bmi < 16, potassium 3.2

strategic family therapy

A patient o. Tamoxifen - what drugs to avoid clozapine etc

ptevention of drug misuse intervention in schools - involve a previous drug dependence patient, opportunities to explore attitudes of drug use, give the same education to all etc 

Statistics on first episode psychosis and cannabis use. Control from population all who have cannabis. Also something about hash canbabis and skunk canbabis 

a table showing odds ratio of  

never use 1

>15 before cannabis use ? 0.46 (0. 37. - 1.

<15 before cannabid use 1.56 (1.

cant remember all the figures 

You find that you are giving slot of advise to a patient in therapy because what the patient said had brought up slot of anxieties in you..... countertransferance, transference, reaction formation

What type of prevention - a patient stopped her antidepressant after her father had a myocardial infarction 

 

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4 hours ago, Gulhane said:

I am really pissed off, i think mrcpsych realized lots of ppl passed before bcz of spmm so they decided to completely change the questions! The first 40 questions were sooooo difficult, i think ill fail. This is my first try and i think it will be the last

I agree with you. A year or so the pass marks were much higher and a lot of the candidates were passing utilising just SPMM.

There has also been a change in the formats of the exam, which might have contributed to it.

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Pretty well set with some repetitions, some pseudo-repetitions and a number of new ones

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17 hours ago, Mmooney said:

The first one was a two-group prospective study on Donepezil vs placebo for agitation in AD. I read through the stem again and again, but couldn't find any information on randomization. they asked what type of study it was, and the options were (a) naturalistic outcome (b) cohort (c) crossover (d) double-blind RCT and one more. there was nothing to suggest it was an RCT. But it wasn't any of the others either. the other questions were data based (NNT etc)

 

I think I picked an option that had RCT followed by open label extension, or something

Yes I also did the same ,I guess it was Parallel group RCT 

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Landau Kleffner crept out of the long grass...

NOT ENOUGH TIME!!!

Completed paper (in a rush) with 4 mins to spare and so no time to scan questions and correct stupid errors. That's 10 marks dropped right there 

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Was I going mad or did the first question ask for NNT for an experimental intervention that was worse than placebo?

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Bad question alert

 

27 year old female. Bilateral annular palmar rash, weeks/months duration, unresponsive to steroids (can't remember if topical or oral) and tetracycline. Now presenting with hypomania. Did she have a temperature too? I can't remember.

Options:

 

Lymes

Syphilis

Giardia

Leishmaniasis

malaria

HSV 1

Bird flu

Notsureiftherewasanother

 

Errrrrrrrrrrrrrmmmm *sobs quietly*

 

Could be Lymes again but would have responded to Tx listed and wouldn't it be unusual to get one tick bite on the palm let alone two?

Likely to be lichen planus which is unresponsive to the treatments listed and commonly occurs on the palms.

Lichen planus (a well known psycho-cutaneous marker, not) could be caused by hepatitis B (and also interferon treatment) or similarly by antimalarial treatment.

Interferons can cause mood changes/psychosis. Is hep B the answer??

I guessed hep B on the basis of palmar erythema (looked the above info up after the exam). TBH though that 1 mark is the least of my problems : /

 

The first 2 in this stem were Lymes and HSV 1 btw.

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A very difficult paper. Still reeling from the impact. No major repeats. There were hardly 8 to 10 questions which were in the spmm or Birmingham courses. Don't know what to make of it. Bad news over all. Heard some guys saying the questions were straightforward but I disagree. Anyways maybe it's time to dump the courses and go back to good old exhaustive study. 

Sobs with low morale. 

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There was a question about defence mechanisms, Lady feeling grandiose in moms funeral? Was it reaction formation or manic defence? 

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Hayat don't ask repeatedly

its manic Defense 

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@Gollu 'don't ask repeatedly' ... when did I ask before ? I think u r very rude, inappropriate & should learn how to converse. 

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I have a q for those who said exam was straight forward. Do u mind telling us where did u study from?

i am a person who paid a huge amount of money to subscribe for spmm as I heard previous reviews that most of q came from it... Just for ppl in the future..its a scam don't buy this, the questions are coming from somewhere else.. This we need to figure out.. The resources..

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1 hour ago, Gulhane said:

I have a q for those who said exam was straight forward. Do u mind telling us where did u study from?

i am a person who paid a huge amount of money to subscribe for spmm as I heard previous reviews that most of q came from it... Just for ppl in the future..its a scam don't buy this, the questions are coming from somewhere else.. This we need to figure out.. The resources..

You don't know about GMC complaint?????????  dr lena palaniyappan is in big trouble because he was posting messages here pretending to be a trainee and recommending spmm.  he tricked many people over years but his reputation is gone when he got caught. he has brought great shame to indian doctors.  you need to ask for you r money back but good luck brother because all spmm doctors have left UK.

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